Toxic anterior segment syndrome-an updated review

Abstract

BackgroundToxic anterior segment syndrome (TASS) can be a rare complication of anterior segment surgery. Here we reviewed the most recent advances in the understanding of TASS.MethodsEnglish articles related to TASS were retrieved from “PubMed” using the following keywords; “toxic anterior segment syndrome” or “TASS”. The authors of this paper reviewed all the retrieved literature and critical findings were summarized.ResultsThe onset of TASS can vary from hours to months. The clinical manifestations are also variable. The causes of TASS are broad and continue to expand and could not be elucidated in over half of the reported cases. Prompt and thorough investigation to explore the causes of TASS is critical. Surgeons should be fully aware and updated regarding possible etiologies and make ceaseless efforts to prevent TASS. This effort begins with establishing TASS prevention protocols and regularly training surgical staff. Proper cleaning of surgical instruments is critical and should follow the guidelines set by The American Society of Cataract and Refractive Surgery TASS Task Force. When TASS occurs, sharing information with other ophthalmologists and reporting new causes is crucial for the prevention of outbreaks.ConclusionsAnterior segment surgeons should be reminded that TASS is mostly preventable by the establishment of TASS prevention protocols, regular surgical staff training and thorough adherence to recommendations for cleaning and sterilizing intraocular surgical instruments.

Characterization of postoperative “fibrin web” formation after canine cataract surgery

“…Anterior chamber reactions, such as flare, cell, and fibrin were the most common clinical findings in one large human case series. Hypopyon, keratic precipitates, and vitreal opacities were observed in less than ¼ of those cases 41 . In 75% of more advanced human cases, the breakdown of the blood‐aqueous barrier results in fibrin formation in the anterior chamber 9 .…”

Toxic Anterior Segment Syndrome with Intracameral Moxifloxacin: Case Report and Review of the Literature

“…It is important to note that both Vigamox and Moxeza are FDA approved for topical use only [ 3 ]. Additionally, Moxeza contains xantham gum which has been associated with TASS [ 1 , 3 ].…”

“…Resulting in often significant anterior segment inflammation, corneal edema, and damage to the iris and angle structures, it has been reported after cataract surgery, penetrating keratoplasty, and intravitreal antivascular endothelial growth factor (VEGF) injections and vitreoretinal surgery. TASS is thought to be the result of toxicity from residue on surgical instruments, disinfectants, medication, and/or preservatives in medications used during surgery [ 1 ]. However, the causative agent remains unknown in many cases.…”

Unilateral Toxic Anterior Segment Syndrome Resulting in Cataract and Urrets-Zavalia Syndrome after Sequential Uneventful Implantation of a Posterior Chamber Phakic Toric Intraocular Lens at Two Different Surgical Facilities: A Series of Unfortunate Events

“…TASS is a very uncommon, but potentially devastating, [ 6 ] complication of intraocular surgery, characterized by a severe, sterile postoperative inflammation generally occurring within days of surgery; although, delayed cases have also been reported [ 7 ]. Overall, between 3 and 20 cases of TASS occur in the United States of America every year [ 8 ].…”